Blood pressure status and risk of cardiovascular disease in older adults aged 75+ without prior cardiovascular events: a nationwide cohort study

AIMS: This nationwide observational cohort study examined the association between hypertension status and cardiovascular disease (CVD) risk in adults aged ≥75 years without prior CVD events. METHODS: Using the Korean National Health Insurance Service (K-NHIS) database, we included individuals aged ≥75 years who underwent health check-ups in 2012-2015. Five statuses of hypertension were defined-normal, pre-hypertension, new-onset hypertension, well-controlled hypertension, and uncontrolled hypertension. The primary outcome was incident CVD (stroke or myocardial infarction). Subdistribution hazard ratios (HRs) were estimated using Fine-Gray models with death as a competing risk. Penalized splines evaluated nonlinear associations of systolic and diastolic blood pressure with outcomes. RESULTS: Among 869,781 participants (mean age 78.49 ± 3.48 years; 41.7% men), 120,353 (13.8%) developed CVD during a mean follow-up of 6.67 years. Compared with normal, pre-hypertension (HR 1.13; 95% CI 1.11-1.16), new-onset hypertension (HR 1.29; 95% CI 1.26-1.33), controlled hypertension (HR 1.21; 95% CI 1.18-1.23), and uncontrolled hypertension (HR 1.33; 95% CI 1.30-1.36) were all associated with higher CVD risk. Similar associative patterns were observed for stroke and myocardial infarction. CONCLUSION: In this large observational cohort, elevated blood pressure (BP) categories were associated with higher risks of stroke and myocardial infarction in adults aged ≥75 years, with the highest risk in uncontrolled hypertension. Stroke risk rose progressively with increasing systolic BP, whereas myocardial infarction demonstrated a U-shaped relationship with diastolic BP. These findings highlight clinically relevant risk patterns in late life and may support future research aimed at optimizing BP assessment in older adults.